Day 5: Oman Outreach – Looking Forward

By Nimrah Abbasi

As the final week of Phase 1 in Oman approaches its end, the emotions are bittersweet and both trainees and trainers are engaged in important conversations about how to ensure that ultrasound skills acquired over the last 18 months are not lost and continue to advance.

ISUOG Oman Outreach Team with Dr Said

To help address many of these concerns, we were delighted to see the support of representatives from the Ministry of Health (MOH) including Dr. Said Al Lamki (Director General of Primary Health Care), Dr. Nawal Al Rashdi (Director of Women’s Health in Women and Child Health in Primary Health Care), Dr. Fatima Al Hinai (Director of Women and Child Health in Primary Health Care) and of course Dr. Mouza, the leader of the Outreach Project from the Royal Qabooz Hospital during an early morning meeting with the trainees and trainers. In this open and honest discussion about current regional needs for sonographers, ultrasound machines and establishment of supportive mentorships between primary healthcare clinics and tertiary centers, potential solutions in reallocation of resources and staffing were discussed. Trainees were also encouraged to voice their individual obstacles to provide safe and comprehensive ultrasound services to women. Additionally, the ISUOG faculty members were given the opportunity to meet with the MOH representatives to discuss the future phases of the Oman Outreach Project and provide recommendations to ensure sustainable ultrasound services for women in Oman. What became clear after this session was the MOH’s unfaltering commitment to improving maternal-child care and women’s health, and specifically to the ISUOG Outreach program and its trainees to ensure their continued growth and success.

Following this fruitful meeting, trainees proceeded with the practical workshops. Today’s task required trainees to complete the 6 steps for a focused basic obstetrical ultrasound examination within 5 minutes. We are thrilled to see that many of the trainees are almost within this time limit, and are again reminded of their remarkable improvement, particularly for the many trainees who started this program with no ultrasound experience. (Picture: Dr Fatma, Dr Mouza and Dr Said).

The afternoon lectures are focused on the standardized gynaecologic examination with emphasis on common adnexal and myometrial pathology. Unfortunately, access to transvaginal ultrasound remains limited within Oman due to a shortage of trained sonographers as well as lack of acceptability for this imaging modality among patients. After discussion with trainees, we understand that much of this reluctance arises from knowledge gaps among the public regarding the utility and diagnostic abilities of this imaging technology, particularly in recognition of many potentially life-threatening conditions such as ectopic pregnancies and placenta previa. Fortunately, a MedaPhor simulator is available for the trainees to practice transvaginal scanning with a multitude of case studies to reinforce many of the principles taught in the lectures. Other discussions among trainees have included various public educational initiatives to promote the use of transvaginal sonography and help reduce some of the associated fear and hesitation.

The program is concluded with an excellent case presentation by one of the trainees, Laila Al-Sulimi discussing a case of fetal hydrops that ultimately resulted in an

intrauterine fetal demise. Trainees were provided with the opportunity to discuss the differential diagnosis of hydrops fetalis, underlying etiologies and additional investigation options including genetic testing and pathologic assessment of the fetus, which many trainees were not familiar with due to the lack of availability of such services throughout the country. (Picture: Dr Nimrah with trainees).

The day ended with what has become a tradition for our Outreach visits to Muscat, a dinner with Drs. Fatima, Nawal and Mouza, and we are touched as always by their hospitality and warmth that make us feel at home in Oman. Tonight we had an unforgettable dining experience at Rozna, an ancient appearing fort inspired by Omani and Islamic heritage. While enjoying traditional Omani cuisine, we reminisce over our Outreach experiences and travels over the last 18 months and plan for the future of this training program in Phase 2. The strength and commitment of these women is inspiring and reminds us of why this Outreach program has been such a success and will undoubtedly serve as a model for future ISUOG outreach programs.